Research Article: Improving emotion recognition in schizophrenia with “VOICES”: An on-line prosodic self-training

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): María Lado-Codesido, Cristina Méndez Pérez, Raimundo Mateos, José Manuel Olivares, Alejandro García Caballero, Jacobus P. van Wouwe.


Emotion recognition (ER) deficits have been extensively demonstrated in schizophrenia. These deficiencies are not only restricted to facial emotion recognition but also include emotional prosody (tone of the voice) recognition deficits. They have been significantly associated with symptom severity and poor social functioning. The aim of this study was to test the efficacy, in real clinical conditions, of an online self-training prosodic game included in the Social Cognition rehabilitation program e-Motional Training.

A randomized, single-blind multicenter clinical trial was conducted with 50 outpatients with schizophrenia or schizoaffective disorder. The control group was treated with Treatment-as-usual (TAU), based on drug therapy, case management and individual and group psychotherapy (not focused on Social Cognition). The intervention group was treated with TAU plus the employment of Voices, an online self-training program devised for prosodic rehabilitation.

Linear regression was used to evaluate the effectiveness of the intervention in emotion recognition measured with the Reading the Mind in the Voice–Spanish Version (RMV-SV).

There were statistically significant differences between the intervention and control group measured with RMV-SV (β = 3,6[IC 95%], p<0.001), with a response variable in RMV post R2 = 0,617. Voices, a prosodic rehabilitation game included in e-Motional Training, seems to be a promising tool for improving emotional voice recognition deficits in schizophrenia, filling the need for such interventions.

Partial Text

Social cognition (SC) is defined as the set of mental operations that underlie social interactions and includes the processes involved in the perception, interpretation and generation of responses when faced with the intentions, dispositions and behaviors of others [1, 2]. As with other mental disorders, SC disorders occurring in schizophrenia entail a reduced ability to adapt to social situations, considering the individuals involved and the context in which these situations occur. This reduced ability entails poor functioning and deficient social integration [3] and is a determinant in the quality of life of individuals with schizophrenia [4].

We conducted a randomized single-blind multicenter clinical trial that selected 53 patients with schizophrenia or schizoaffective disorder. Fifty-three patients were approached and none of them declined to participate in this study. The patients were recruited from the following 5 centers: University Hospital of Ourense, University Hospital Complex of Ferrol, University Hospital Complex of Vigo, the Ceboliño residence (Ourense) and the Professional Association of Patients with Mental Illnesses of Carballo (A Coruña). After recruitment, the sample was randomized in each center into two balanced groups (Fig 1). Three of the recruited patients were lost to follow-up, 2 in the control group and 1 in the intervention group (control n = 24, intervention n = 26). Therefore, the final sample was composed by 50 patients.

A total of 53 participants were selected and assigned to control group (TAU) or to the intervention group (Voices+TAU). Three of them did not finish the clinical trial (two of control group and one of intervention group), therefore statistical analysis has been performed over a sample of 50.

The results of this study suggest that the use of the Voices program improves the prosodic test scores of patients with schizophrenia or schizoaffective disorder compared with patients who are undergoing conventional rehabilitation programs. The use of this type of program could represent an improvement in the level of auditory emotion recognition and could therefore be an advance in the patients’ global psychosocial function.




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